The Role of Vitamin D in Controlling and Managing Glycaemic Control in Patients with Type 2 Diabetes (D4D)

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๐—•๐—ฎ๐—ฐ๐—ธ๐—ด๐—ฟ๐—ผ๐˜‚๐—ป๐—ฑ: There is growing evidence indicating the link between serum 25-hydroxy-vitamin D (25(OH)D) level and Type 2 Diabetes Mellitus (T2DM). Many large cohort observational studies have confirmed an inverse association between serum 25(OH)D level and T2DM risks, while Randomised Control Trials (RCTs) have presented inconsistent results. It was therefore decided to conduct a literature review of current RCTs to identify limitations, design and conduct a more rigorous RCT, i.e. D4D trial, to evaluate the association between serum 25(OH)D level and T2DM. ๐— ๐—ฒ๐˜๐—ต๐—ผ๐—ฑ: D4D trial was a long-term, multi-centre, single-blind, four-arm parallel-group trial. Eligible participants were randomised to receive vitamin D from interventions: 1) 10-15 ยตg/day (400-600 IU/day) from food, 2) 12.5 ยตg/day (500 IU/day) from sunlight exposure, 3) 12.5 ยตg/day (500 IU/day) from supplements or 4) waitlist without intervention, for nine months. Serum 25(OH)D level, HbA1c and lipids levels were measured at baseline, 3rd, and 9th month after the intervention. ๐—ฅ๐—ฒ๐˜€๐˜‚๐—น๐˜๐˜€: 60 participants were recruited in the D4D trial, with 15 participants per intervention group. Results suggested serum 25(OH)D was inversely associated with HbA1c level but was not statistically significant. Detailed results as following: 1) Serum 25(OH)D level in Diet group at 9th month was significantly increased compared to Waitlist group (p=0.0068) and Supplement group (p=0.0392), 2) Serum 25(OH)D in Diet group at 9th month was significantly increased compared to baseline (p=0.0166) and 3rd month (p=0.0268); 3) Serum 25(OH)D level in Sun exposure group at 3rd month and in Supplement group at 9th month was significantly increased compared to their baseline (p=0.0361 and p=0.0319); 4) HbA1c level in Diet group (p=0.0279) at 9th month was significantly reduced compared to Waitlist group, 5) HbA1c level in Diet group (p=0.0039) and Supplement Group (p=0.0332) at 3rd month and Diet group (p=0.0299) at 9th month also presented significant decreases compared to baseline, 6) Lipids levels were not significantly changed by the interventions. ๐—–๐—ผ๐—ป๐—ฐ๐—น๐˜‚๐˜€๐—ถ๐—ผ๐—ป: Dietary vitamin D is the most effective source to increase Serum 25(OH)D levels and improve glycaemic control among T2DM patients. Vitamin D from sun and supplements requires a large dosage and a medium to long intervention time to show the effects. Future well-designed clinical trials should assess the vitamin D from natural lifestyle interventions to distinguish vitamin Dโ€™s effect on glycaemic control from the confounding factors and generate feasible and patient-oriented suggestions.
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